BACKGROUND: In patients with myocardial infarction, one needs to know the location, extent and severity of wall motion abnormalities to assess prognosis and guide therapy. Thus more precise quantatative estimates of regional ventricular function are required. Regional wall motion has generally been assessed by displaying the multiple cardiac images of RVG as endless-loop movie, but the cinematic display was not objective. We used the usefulness of the phase analysis in evaluating the global left ventricular function and regional wall motion abnormalities of patients with myocardial infarction. The accuracy of the RVG cinematic display in detecting regional wall motion abnormalities in patients with myocardial infarction was also evaluated. METHODS: Studied cases were 97 patients with myocardial infarction and 20 normals with low likelihood of coronary artery disease. Coronary angiography and contrast left ventriculography were performed in all patients with myocardial infarction. The regional wall myocardial infarction(presence) is defined when the EKG presented the evidence of myocardial infarction, left ventriculogram showed RWMA(regional wall motion abnormality) along with stenosis of 50% or greater of the regional supplying coronary artery. Each patient was imaged in 45 left anterior oblique(LAO) view, anterior(Ant) view and left lateral(Lt Lat) view. We evaluated Left ventricular ejection fraction(LVEF) from time-activity curve. We constructed the histogram for the left ventricle and both ventricle separately to obtain the global and total phase angle(GPA, TPA), standard deviation of phase angle(GSDPh, TSDPh), full width half maximum(GFWHM, TFWHM). The left ventricle was divided into 7 segments. LAO projection ; septal, apical, basal lateral, apical lateral, Ant projection ; anterolateral, Lt Lat projection ; inferior, posterior, Phase angle(RPA) and full width half maximum(RFWHM) from the histogram (regional 7 segments) were examined. On the RVG cinematic display, the standard 4 grading system was used, normal, hypokinesia, akinesia, dyskinesia. The observer evaluated regional wall motion abnormality of the 7 segments for all cases. The sensitivity of the above parameters and RVG cinematic display was evaluated. We analyzed the regional parameters among the patents with regional wall myocardial infarction(presence), those without regional wall myocardial infarction(absence) and control group using the t-test. The statistical analysis was done by one way ANOVA between regional phase analysis and RVG cinematic display. RESULTS: The sensitivity of LVEF was lowest(70.1%) and the GFWHM was highest among the global parameters(89.1%). But RFWHM showed even higher sensitivity(96.9%), thus regional phase analysis was also required. The RVG cinematic display was also sensitive(92.7%), but less sensitive than the RFWHM. On regional phase analysis the RPA of septal, apical, inferior, posterior walls of the left ventricle was able to separate presence group from absence group and also presence group from control group and the RPA of the apical lateral wall could separate presence group from absence group. The RPA of basal lateral and anterolateral wall was inaccurate in diagnosing the regional wall myocardial infarction, because basal lateral wall was overlapped by adjacent vascular structures, and the area of anterolateral wall dose not correlate completely beteen the RVG & the left ventriculogram, also the anterolateral wall can be supplied by the obtuse marginal branch of left circumflex artery. The RFWHM of all regional walls of left ventricle could separate presence group from absence group and presence group from control group. We found good correlation between regional phase analysis & left ventriculogram for detection of regional wall myocardial infartion. On RVG cinematic display, the RPA of the normal group was different from that of dyskinesia, akinesia and hypokinesia groups. The RPA of the dyskinesia group was also different from that of skinesia and hypokinesia groups by oneway ANOVA(p<0.05). The RFWHM of the dskinesia group was different from that of the normal group and hypokinesia group. RVG cinematic display correlated well with regional phase analysis and also quantitation of wall motion. CONCLUSIONS: Thus RVG cinematic display was useful and can not be replaced by phase analysis. But the regional phase analysis was sensitive and objective in diagnosing the wall motion abnormality in myocardial infarction.
Ants ; Arteries ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Dyskinesias ; Electrocardiography ; Heart Ventricles ; Humans ; Hypokinesia ; Myocardial Infarction* ; Prognosis ; Radionuclide Ventriculography ; Ventricular Function ; Ventricular Function, Left

We performed radionuclide ventriculography before and within 1 week after percutaneous mirtal valvuloplasty(PMV) to evaluate left ventricular(LV) function in 20 patients(3 males and 17 females, mean age of 38±10 years) who were pure mitral stenosis before PMV and less than grade 1 mitral regurgitation developed after PMV. 9 out of 20 patients had atrial fibrillation and 3 patients developed a small left-to-right shunt(Qp/Qs<1.5)after PMV using double-balloon technique resulted in a increase in mitral valve area(0.9±0.3 to 2.1±0.8mm
Atrial Fibrillation ; Cardiac Output ; Female ; Humans ; Male ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis* ; Radionuclide Ventriculography ; Stroke Volume

BACKGROUND: There has been no clinical study of skin problems of the amputee in Korea and at Veterans Hospital, we have experienced so many skin problems of amputees. OBJECTIVE: We tried to observe skin problems of amputees and to relate them with sweating, poor hygiene, poor fit of socket, mechanical trauma, and duration of wearing prosthesis. METHODS: 125 extremity amputees who visited the Seoul Veterans Hospital during the period of 5 years from Jan. 1994 to Dec. 1998 were analyzed clinically. RESULTS: The study results are summarized as follows: 1. Among the 125 extremity amputees, the number of male patients was 124(99.2%) and that of female patients was 1(0.8%). The age distribution showed a peak incidence in the 7th decade(30.4%), followed by the 5th decade(28.8%), 6th decade(24.8%), and the mean age was 56.4 years. 2. The most common type of amputation was below the knee amputation(74 cases), the second was above the knee amputation(37 cases). 3. The duration of wearing prosthesis was above 20 years in 88 patients(70.4%), 16-20 years in 15(12%), 11-15 years in 11(8.8%), and 1-5 years in 6(4.8%). 4. The skin problems of the amputees were superficial fungal infection, chronic ulcer, intertriginous dermatitis, callus, corn, verrucous hyperplasia, verruca which were 63 cases(50.4%), 26 cases(20.80%), 17 cases(13.6%), 6 cases(4.8%), 5 cases(4%), 5 cases(4%), 3 cases(2.4%) respectively. 5. The predisposing factors of the dermatoses were mechanical trauma(84 cases) which acted as a cause of the chronic ulcer, intertriginous dermatitis, corn and callus, sweating(80 cases) and poor hygiene(11 cases) as those of superficial fungal infection, and poor fitting(6 cases) as that of verrucous hyperplasia. CONCLUSION: Superficial fungal infection and chronic ulcer were the main skin problems of the amputee. The longer the duration of wearing prosthesis, the more skin problems developed. The mechanical trauma and sweating were the major predisposing factors of stump dermatoses, especially of chronic ulcer and superficial fungal infection. Amputation is only the beginning of a long period of rehabilitation, and the treatment of the patient and the affected skin goes on for the rest of the patient's life. This clinical study suggests that the dermatologist must be concerned of the care of amputee's skin problems.
Age Distribution ; Amputation ; Amputees* ; Bony Callus ; Causality ; Dermatitis ; Extremities ; Female ; Hospitals, Veterans ; Humans ; Hygiene ; Hyperplasia ; Incidence ; Knee ; Korea ; Male ; Prostheses and Implants ; Rehabilitation ; Seoul ; Skin Diseases ; Skin* ; Sweat ; Sweating ; Ulcer ; Warts ; Zea mays

A study was conducted to present clinical and statistical analysis of pediatric patients admitted to Severance Hospital between Jan. 1966 and Dec. 1975. Remakable progress has been made in the field of pediatrics and pediatric surgery, particularly in physiology, anesthesiology and operative technique. However, the ultimate result hasn't been totally satisfactory, largely due to the lack of cognizance of early diagnosis and prompt treatment. Futhermore, most of the patients with associated abnormal conditions, such as congenital heart disease, other associated G.I. anomalies and chromosomal anomalies, require surgery, urgently A total of 250 cases were analyzed according to systems. The following results were obtained; 1. 1. In the sex ratio male to female was 6-7:1. 2. 2. The order of frequency of diseases was as follows; Congenital megacolon 50 cases(20.0%), Imperforated anus 45 cases (18.0%), Congenital hypertrophic pyloric stenosis 41 cases(16.4%), Congenital anomalies of intestine 29 cases (11.6%), Congenital anomalies of hepatobiliary system 25 cases(10.0%), Meckel's diverticulum 18 cases(7.2%), Situs inversus 11 cases (4.4%), Congenital diaphragmatic hernia 6cases(2.4%), Congenital anomalies of cecum 6 cases(2.4%), Esophageal diverticulum 6 cases (2.4%), Esophagealatresia 4 cases (1.6%), Congenital anomalies of pancreas 4 cases (1.6%), Patent omphalomessentric duct 2 cases (0.8%), Congenital intestinal perforation 2 cases (0.8%), and Congenital stomach perforation 1 cases (0.4%). 3. There was an overall mortality rate of 36 cases (18.9%), the causes of death were frequently associated with respiratory failure. 4. Associated congenital anomlies were found in 57 cases. They were G. I. Anomalies, congenital heart diseases, Down's syndrome and cleft palate. 5. Of significance was the fact in this study, congenital megacolon had the highest incidence which was in sharp contrast to accidental series in which congenital hypertrophic pyloric stenosis showed the peak incidence. These figures are very similar to that reported in various publications. This analysis suggest that a more keen understanding of neonatal physiology, embryology, surgical technique and improved post-operative care for anomalous patients, may certainly improve the ultimate outcome of corrective surgery.
Anal Canal ; Anesthesiology ; Cause of Death ; Cecum ; Cleft Palate ; Digestive System* ; Diverticulum, Esophageal ; Down Syndrome ; Early Diagnosis ; Embryology ; Female ; Heart Defects, Congenital ; Heart Diseases ; Hernia, Diaphragmatic ; Hirschsprung Disease ; Humans ; Incidence ; Intestinal Perforation ; Intestines ; Male ; Meckel Diverticulum ; Mortality ; Pancreas ; Pediatrics ; Physiology ; Pyloric Stenosis, Hypertrophic ; Respiratory Insufficiency ; Sex Ratio ; Situs Inversus ; Statistics as Topic* ; Stomach

No abstract available.
Chromatography, Liquid* ; Ciprofloxacin* ; Therapeutic Equivalency*

BACKGORUND: infusion of propofol by a target-controlled infusion (TCi) system is effective in achieving conscious sedation for anxious patients presenting for dental surgery. However, there is no report of conscious sedation for mandibular fracture patients using propofol TCi. The objective of this study was to evaluate the appropriation of a conscious sedation using propofol for mandibular fracture patients. METHODS: Twenty patients with a mandibular fracture undergoing an open reduction and miniplate insertion operation were analyzed. We anesthetized patients using a propofol infusion by a TCi system (Diprifusor :Master TCi:Pilot Anesthesia is, France) with local anesthesia using lidocaine. The BiS score was evaluated continually during surgery using a microcomputer (A-2000 BiS monitor , Aspect Medical System, USA). We set the infusion machine at a target concentration 2mug/ml, and adjusted the propofol concentration for a BiS score range of 80-85. infusion rate, total dosage, duration of induction, recall of operative procedure and cooperation scores were checked. BiS, heart rate, noninvasive arterial blood pressure, and SpO2 were recorded during the operation. RESULTS: The mean BiS score was 82.95, the mean target concentration of propofol was 2.645mug/ml, the mean infusion rate was 136.3mug/kg/min, and the mean cooperation score was 2.5, the patients were cooperative. The score of amnesia was 0.2, almost patients did not recall the intraoperative event. The mean duration of stay in the recovery room was 22.2 minutes, and the most frequent side effect was pain on injecion of propofol. CONCLUSiONS: Conscious sedation with propofol TCi is an effective anesthesia method substitute for general anesthesia with quick emergence, few side effects, and safety for mandibular fracture patients.
Amnesia ; Anesthesia ; Anesthesia, General ; Anesthesia, Local ; Arterial Pressure ; Conscious Sedation* ; Heart Rate ; Humans ; Lidocaine ; Mandibular Fractures* ; Microcomputers ; Propofol* ; Recovery Room ; Surgical Procedures, Operative

No abstract available.
Dermatitis, Seborrheic* ; Lice Infestations*

No abstract available.
Dermatitis, Seborrheic* ; Lice Infestations*

PURPOSE: Epilepsy is the most common neurological disorder in childhood. Hospital nurses, who are the first to recognize seizures in epilepsy patients in the ward environment, possess expertise related to epilepsy and play a central role in epilepsy management. The purpose of this study was to develop an algorithm-based education program and to improve nurses' knowledge and self-efficacy related to providing nursing care to children with epilepsy. METHODS: The education program consisted of lectures on the definition, cause, classification, diagnosis, treatment, and nursing of epilepsy based on a booklet, as well as practice using an algorithm for nursing interventions when a child experiences a seizure. Twenty-seven nurses working at pediatric neurological wards and a pediatric emergency room participated in the education program. The data were analyzed using descriptive statistics and the paired t-test. RESULTS: Nurses' knowledge and self-efficacy showed a statistically significant improvement after participation in the education program on nursing care for children with epilepsy. CONCLUSION: The application of this education program for hospital setting is expected to improve nurses' capability to care for children with epilepsy, thereby contributing to a higher quality of nursing.
Child ; Classification ; Diagnosis ; Education ; Education, Nursing ; Emergency Service, Hospital ; Epilepsy ; Humans ; Lectures ; Nervous System Diseases ; Nursing Care ; Nursing ; Pamphlets ; Seizures

OBJECTIVE: To investigate the correlation of multifidus muscle atrophy on MRI findings with clinical findings in low back pain patients. METHOD: Medical records of 80 patients presenting with low back pain were retrospectively reviewed. Their MR images were visually analysed to know lumbar multifidus muscle atrophy, disc herniation, disc degeneration, spinal stenosis and nerve root compression. RESULTS: Multifidus muscle atrophy increased from the upper lumbar level to the most caudal intervertebral level. It was bilateral in the majority of the cases. Multifidus muscle atrophy was well correlated with patient's age, referred leg pain, and disc degeneration. However, duration of low back pain, disc herniation, spinal stenosis, nerve root compression, sex, weight, height and BMI had no correlation with multifidus muscle atrophy. CONCLUSION: Examination of multifidus muscle atrophy should be considered when assessing MR images of lumbar spine. It may help for further evaluation and planning the treatment modalities of low back pain.
Atrophy* ; Humans ; Intervertebral Disc Degeneration ; Leg ; Low Back Pain* ; Magnetic Resonance Imaging ; Medical Records ; Muscular Atrophy ; Paraspinal Muscles* ; Radiculopathy ; Retrospective Studies ; Spinal Stenosis ; Spine